Thursday 12th May 2016- The World Health Organisation:Rapid diagnostic test and shorter, cheaper treatment signal new hope for multidrug-resistant tuberculosis patients

‘New WHO recommendations aim to speed up detection and improve treatment outcomes for multidrug resistant tuberculosis (MDR-TB) through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen.

“This is a critical step forward in tackling the MDR-TB public health crisis,” said Dr Mario Raviglione, Director of WHO’s Global TB Programme. “The new WHO recommendations offer hope to hundreds of thousands of MDR-TB patients who can now benefit from a test that quickly identifies eligibility for the shorter regimen, and then complete treatment in half the time and at nearly half the cost.”’

‘At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.

The conventional treatment regimens, which take 18–24 months to complete, yield low cure rates: just 50% on average globally. This is largely because patients find it very hard to keep taking second-line drugs, which can be quite toxic, for prolonged periods of time. They therefore often interrupt treatment or are lost to follow-up in health services.’

‘WHO’s recommendations on the shorter regimens are based on initial programmatic studies involving 1200 patients with uncomplicated MDR-TB in 10 countries . WHO is urging researchers to complete ongoing randomised controlled clinical trials in order to strengthen the evidence base for use of this regimen.’

‘The most reliable way to rule out resistance to second-line drugs is a newly recommended diagnostic test for use in national TB reference laboratories. The novel diagnostic test – called MTBDRsl – is a DNA-based test that identifies genetic mutations in MDR-TB strains, making them resistant to fluoroquinolones and injectable second-line TB drugs.’

‘This test yields results in just 24-48 hours, down from the 3 months or longer currently required. The much faster turnaround time means that MDR-TB patients with additional resistance are not only diagnosed more quickly, but can quickly be placed on appropriate second-line regimens. WHO reports that fewer than 20% of the estimated 480 000 MDR-TB patients globally are currently being properly treated.’

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Rapid diagnostic test and shorter, cheaper treatment signal new hope for multidrug-resistant tuberculosis patients

Friday 22nd January 2016- The Guardian: Breast milk protein could be used in fight against antibiotic resistance

‘An antibiotic developed from human breast milk could combat certain drug-resistant bacteria, British scientists have found.

Tackling antibiotic-resistant bacteria – known as superbugs – is a priority for the government. A panel set up by David Cameron forecast that superbugs would cost the world ten million lives and £700bn a year by 2050 if the problem went unchecked.

The breakthrough, developed by the National Physical Laboratory (NPL) and University College London, found that the minuscule fragment, less than a nanometre in width, is responsible for giving the protein its anti-microbial properties.

This is what makes breast milk so important in protecting infants from diseases in their first months of life. The protein, called lactoferrin, effectively kills bacteria, fungi and even viruses on contact.

After identifying the fragment, scientists re-engineered it into a virus-like capsule that can recognise and target specific bacteria and damage them on contact, but without affecting any surrounding human cells.

Hasan Alkassem, a student who worked on the project, said: “The capsules acted as projectiles … with bullet speed and efficiency.”

The team suggested this could help the fight against antibiotic resistance by serving as “delivery vehicles” for cures. The capsules could even pave the way for treatments for previously incurable diseases such as sickle-cell disease, cystic fibrosis or Duchenne muscular dystrophy.’

Related Articles:

Breast milk protein could be used in fight against antibiotic resistance

Scientists discover new antibiotic from breast milk- The Telegraph

Wednesday 18th November 2015- BBC News: Antibiotic surge revealed by seasonal maps

‘A huge and potentially inappropriate surge in antibiotic prescriptions in the winter has been identified through the first detailed maps of seasonal prescribing in England.

The charity Antibiotic Research UK, which compiled the data for the BBC, said the surge could not be explained by extra bacterial infections.

It said it was probably due to doctors handing out pills for colds and flu.

Experts said an acceptable prescribing level was still unclear.

There is a noticeable winter cold and flu season, when the viruses find it easier to spread.

Some bacterial infections are also more common in the winter – such as pneumonia, partly as a result of secondary infections in people whose lungs have been damaged by viral infections.

But others, such as urinary tract infections, are actually more common in summer.

Prof Colin Garner, of Antibiotic Research UK, told the BBC News website: “You would expect bacterial infections to possibly go up in winter.

“But they don’t go up as dramatically as the heat map shows – 50% more in December compared to August.

“So the map reflects, in all probability, an over-prescribing of antibiotics at that time of year.”‘

‘The National Institute of Health and Care Excellence has argued that 10 million antibiotic prescriptions are inappropriate each year.

The concern is that high levels of antibiotic use are leading to bacteria developing resistance to the drugs and becoming untreatable.

Prof Mike Sharland, a Department of Health adviser on antibiotics, said the summer-winter difference was “recognised as a global problem”.’

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Antibiotic surge revealed by seasonal maps

Friday 18th September 2015- The Independent: Gonorrhoea outbreak: National alert triggered over drug-resistant strain

‘English health authorities have issued a warning over the outbreak of a highly drug resistant strain of gonorrhoea in the north of England.

Public Health England (PHE) has found 15 cases so far, according to the British Association for Sexual Health and HIV (BASHH).

The first was detected in Leeds back in March, but the infection has since spread — at least to Macclesfield, Oldham and Scunthorpe.

All infected patients have been heterosexual, and some reported having recently had sex with people from other parts of England.

What makes this particular STD a national concern is just how difficult it is to get rid of. According to PHE records, this strain has exhibited a rare resistance to the azithromycin drug.

In a statement, BASHH said: “An outbreak control team meeting has been convened and [the bacteria reference unit] are currently performing next generation sequencing on these strains to better understand the molecular epidemiology.”

It added: “PHE is concerned that the effectiveness of current front-line dual therapy for gonorrhoea will be threatened if this resistant strain continues to spread unchecked.”‘

Related Articles:

Gonorrhoea outbreak: National alert triggered over drug-resistant strain

Drug-resistant gonorrhoea outbreak sparks England-wide alert- The Guardian

‘Super-gonorrhoea’ outbreak in Leeds- BBC News

‘Super-gonorrhoea’ outbreak across north of England sparks national alert- The Telegraph

Wednesday 29th April 2015- World Health Organisation: WHO report finds systems to combat antibiotic resistance lacking

‘A quarter of countries that responded to a WHO survey have national plans to preserve antimicrobial medicines like antibiotics, but many more countries must also step up. A new report, “Worldwide country situation analysis: Response to antimicrobial resistance”, which outlines the survey findings, reveals that while much activity is underway and many governments are committed to addressing the problem, there are major gaps in actions needed across all 6 WHO regions to prevent the misuse of antibiotics and reduce spread of antimicrobial resistance.’

‘Issued a year after WHO’s first report on the extent of antimicrobial resistance globally, which warned of a ‘post-antibiotic era’, this survey—which was completed by 133 countries in 2013 and 2014—is the first to capture governments’ own assessments of their response to resistance to antimicrobial medicines used to treat conditions such as bloodstream infections, pneumonia, tuberculosis (TB), malaria and HIV. It summarizes current practices and structures aimed to address the issue, and shows there are significant areas for improvement.’

‘Key findings of the report include:

• Few countries (34 out of 133 participating in the survey) have a comprehensive national plan to fight resistance to antibiotics and other antimicrobial medicines.
• Monitoring is key for controlling antibiotic resistance, but it is infrequent. In many countries, poor laboratory capacity, infrastructure and data management are preventing effective surveillance, which can reveal patterns of resistance and identify trends and outbreaks.
• Sales of antibiotics and other antimicrobial medicines without prescription remain widespread, with many countries lacking standard treatment guidelines, increasing the potential for overuse of antimicrobial medicines by the public and medical professionals.
• Public awareness of the issue is low in all regions, with many people still believing that antibiotics are effective against viral infections.
• Lack of programmes to prevent and control hospital-acquired infections remains a major problem.’

Related Articles:

WHO report finds systems to combat antibiotic resistance lacking

Most countries not protecting antibiotics, says WHO- BBC News

Thursday 19th February 2015-The Telegraph: Los Angeles hospital says more than 100 exposed to drug-resistant ‘superbug’

‘Half a dozen people were infected and more than 100 exposed to a potentially deadly, drug-resistant “superbug” on contaminated medical instruments at a medical centre in Los Angeles.

Patients at Ronald Reagan UCLA were exposed to CRE [Carbapenem-Resistant Enterobacteriaceae] during endoscopic procedures between October and January, the University of California, Los Angeles said in a statement.

It may have been a “contributing factor” in the deaths of two patients, the university said.’

‘The bacteria can cause infections of the bladder or lungs, leading to coughing, fever or chills. CRE infections have been reported in every state except Idaho, Alaska and Maine, according to the CDC.

UCLA said infections may have been transmitted through endoscopes used during the diagnosis and treatment of pancreatic and bile-duct problems.’

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Los Angeles hospital says more than 100 exposed to drug-resistant ‘superbug’

Thursday 11th December 2014- The Guardian: Drug-resistant infections could lead to 10 million extra deaths a year

After Prime Minister David Cameron commissioned Jim O’Neill in July 2014 to review the status of antimicrobial resistance, it has been reported that ‘Failure to tackle drug-resistant infections will lead to at least 10 million extra deaths a year and cost the global economy up to $100tn (£64tn) by 2050.’

The article continues to contextualise these figures, demonstrating that ‘there are currently 8.2 million deaths a year from cancer and annual global GDP stands at $70tn to $75tn, with the UK figure around $3tn.’

The review placed emphasis on researching the progress of 3 bacteria: carbapenem-resistant K pneumoniae (CRKP), Escherichia coli and Staphylococcus aureus (MRSA), but ‘also examined HIV, tuberculosis and malaria as broader public health issues for which resistance is a concern’.

‘The world’s most populous countries, India and China, face 2 million and 1 million deaths a year respectively by 2050 and one in every four deaths in Nigeria’, while currently the ‘“low estimate” of the current number of annual global deaths is put at 700,000’.

See:

Drug-resistant infections could lead to 10 million extra deaths a year

Friday 7th March 2014- BBC News: Warning over hospital superbug linked to 16 deaths

‘Klebsiella pneumoniae carbapenemase (KPC) is causing increasing concern and a rising number of cases.

Some 1,241 patients were affected within the Central Manchester University Hospitals trust area from 2009 to 2013, the figures show.’

‘The figures, revealed in a Freedom of Information request by the BBC, found 62 patients so far have suffered blood poisoning – with 14 confirmed deaths within 30 days of infection – at Central Manchester University Hospitals NHS Foundation Trust.

Two further deaths have occurred in the current year, the hospital trust confirmed.’

‘KPC, which causes urinary tract infections and pneumonia in sick patients, is resistant to carbapenems, the last major group of antibiotics to work against multidrug-resistant bacteria.

The trust said the chemical, an enzyme, that KPC uses to render antibiotics ineffective had now entered other bacteria, including E. coli and Enterobacter.

“This trust has and continues to make strenuous efforts to control and reduce this infection. We continue to work very closely with Public Health England at both a local and national level to develop solutions for the long-term management of patients,” it said.’

See:

Warning over hospital superbug linked to 16 deaths

Superbug kills 16 people in Manchester NHS hospital trust– The Independent

Superbug kills 16 in Manchester hospitals– The Guardian